氯沙坦治疗轻中度原发性高血压病的临床研究──附57例报告

Losartan in the treatment of mild to moderate essential hypertension

探讨氯沙坦治疗轻、中度原发性高血压病的临床疗效。方法：113例原发性高血压患者随机分为两组，氯沙坦组（治疗组，57例）：50～100mg／d口服，疗程半年；依那普利组（对照组，56例）：5～15mg／d口服，疗程半年。治疗前后做动态血压监测，肝、肾功能，血糖等检查，测定血浆肾素活性（PRA）、血管紧张素Ⅱ（AngⅡ）、醒固酮、内皮素等。结果：治疗组降压总有效率为72％（41例）；降压幅度（kPa）收缩压为3．4，舒张压为1．7；谷／峰比值（收缩压0．82，舒张压0．80）。分别与对照组总有效率73％（41例）；降压幅度（kPa）收缩压为3．3、舒张压为1．8，谷／峰比值（收缩压0．83，舒张压0．80）相似。两组治疗后PRA、AngⅡ增高，醛固酮、内皮素降低且治疗组AngⅡ升幅、醛固酮降幅均较对照组显著（P＜0.05）。氯沙但不良反应轻微。结论：氯沙但是一种安全、作用持续稳定、耐受性良好、不良反应轻微的治疗轻、中度原发性高血压病的新型降压药物之一，值得临床推广应用。

Objective: To investigate the efficacy and safety of losartan in the treatment of mild to moderate essential hypertension.Methods: 113 cases were randomly assigned into two groups. Patients in the first group (57 catses) werelgiven 50 mg to 100 mg of losartan once daily Those in second group (56 cases) were given 5 mg to 15 mgof .enalapril once daily, the course was 24 weeks. Ambulatory blood pressure monitoring (ABPM), hepatic and renalfunction, blood glucose, plasma renin activity (PRA), angiotensin Ⅱ (Ang Ⅱ). aldosterone (Ald), and endothelin(ET) were examined before and after therapy Results: The total efficacy rate, amplitude of SBP and DBP lowered,and SBP and DBP trough to peak ratio (T/P) in losartan group were 72%, 3. 4 kPa, 1. 7 kPa, 0. 82 and 0. 80 respectively, while that in enalapril group was 73%, 3. 3 kPa, 1. 8 kPa, 0. 83 and 0. 80, respectively (P>0. 05). PRA andAng Ⅱ were increased, while Ald and ET decreased after the therapy in both groups (P<0. 05), The change of AngⅡand Ald was greater in losartan group (P< 0. 05). The adverse reactions of losartan were mild. Conclusion:Losartan is a safe and reliable antihypertensive agent which lowers blood pressure persistantly and smoothly. It is recommended as one of routine therapies in the treatment of mild to moderate essential hypertension